Effect of intraoperative blood pressure on incidence of hematoma in breast reduction mammoplasty: Blood pressure and hematoma in BRM

Background: Postoperative hematomas are among the most frequent complications following breast reduction mammoplasty (BRM). Intraoperative hypotension has been implicated in the development of postoperative hematomas following breast reduction. In this study, we performed a retrospective, propensity-matched analysis of patients undergoing primary breast reduction to determine the relationship between intraoperative blood pressure and the development of a postoperative hematoma. Methods: A retrospective review of all patients that underwent BRM at a single institution from 2017 to 2019 (n = 563) was conducted. Patients who developed a postoperative hematoma were propensity matched to two controls based on body mass index (BMI) and age. The mean systolic blood pressure (SBP) and average mean arterial pressure (MAP) were recorded for each third of the operation. Data were analyzed using conditional logistic regression. Results: Thirty-two patients that developed postoperative hematomas were propensity matched to 64 controls. There was no difference in baseline SBP, diastolic blood pressures, or prevalence of hypertension between groups. There was no significant difference in average SBP or MAP between groups. The average MAP during the first third of the procedure was found to be lower in patients who developed a hematoma (69 vs. 72 mmHg), which approached significance at p = 0.08. Closed suction drains were used in 53% of the hematoma group and 78% of the control group (p = 0.02). Conclusion: There does not appear to be an association between intraoperative blood pressure and the incidence of hematoma when comparing patients who developed hematomas after BRM to propensity-matched controls.